不同消融方式对心房颤动患者凝血参数、心肌损伤以及生活质量的影响

摘要 目的：探讨不同消融方式对心房颤动患者凝血参数、心肌损伤以及生活质量的影响。方法：回顾性分析2018年1月至2019年7月在我院心血管内二科住院拟行消融手术的心房颤动患者200例的临床资料，根据消融方式分为射频消融（RFCA）组（n=99）和冷冻消融（CBA）组（n=101），比较两组患者围术期指标、凝血参数、心肌损伤以及生活质量，记录两组术后并发症发生情况。结果：CBA组手术时间、消融时间短于RFCA组，冷冻最低温度低于RFCA组（P<0.05）。两组术后 24 h活化部分凝血活酶时间（APTT）降低，但CBA组高于RFCA组（P<0.05），两组术后 24 h血管性假血友病因子（vWF）、D-二聚体（D-D）升高，但CBA组低于RFCA组（P<0.05）。两组术后 24 h肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）、肌钙蛋白 I （TnI）较术前升高，且CBA组高于RFCA组（P<0.05）。两组术后3个月情感职能、躯体疼痛、生理机能、精神健康、活力、生理职能、健康状况、社会功能维度评分较术前升高，且CBA组高于RFCA组（P<0.05）。两组并发症发生率对比未见统计学差异（P>0.05）。结论：与RFCA相比，CBA治疗心房颤动，可缩短手术时间、消融时间，减轻对凝血功能的影响，提高患者生活质量，且不增加并发症发生率，但CBA对机体心肌损伤影响更大，临床应视患者具体情况选择合适的手术方法进行治疗。

Effects of Different Ablation Methods on Coagulation Parameters, Myocardial Injury and Quality of Life in Patients with Atrial Fibrillation

ABSTRACT Objective: To investigate the effects of different ablation methods on coagulation parameters, myocardial injury and quality of life in patients with atrial fibrillation. Methods: The clinical data of 200 patients with atrial fibrillation who were hospitalized in Second Department of Internal Medicine-Cardiovascular of our hospital from January 2018 to July 2019 were analyzed retrospectively. According to the ablation methods, they were divided into radiofrequency ablation (RFCA) group (n=99) and cryoablation (CBA) group (n=101). The perioperative indexes, coagulation parameters, myocardial injury and quality of life of the two groups were compared. The postoperative complications of the two groups were recorded. Results: The operation time and ablation time of CBA group were shorter than those of RFCA group, and the lowest freezing temperature was lower than that of RFCA group(P<0.05). The activated partial thromboplastin time (APTT) decreased at 24 hours after operation in both groups, but CBA group was higher than RFCA group (P<0.05). The von Willebrand factor (vWF), D-Dimer (D-D) increased at 24 hours after operation in both groups, but CBA group was lower than RFCA group(P<0.05). The creatine kinase (CK), creatine kinase isoenzyme (CK-MB), troponin I (TNI) at 24 hours after operation in both groups were higher than those before operation, and CBA group was higher than RFCA group(P<0.05). The scores of emotional function, physical pain, physiological enginery, mental health, vitality, physiological function, health status and social function in both groups were higher than those before operation, and CBA group was higher than RFCA group (P<0.05). There was no significant difference in the incidence of complications between the two groups(P>0.05). Conclusion: Compared with RFCA, CBA is used to treat atrial fibrillation, can shorten the operation time and ablation time, reduce the influence on coagulation parameters, improve the quality of life of patients, and do not increase the incidence of complications, but CBA has a greater impact on the body myocardial injury, so we should choose the appropriate operation method according to the specific situation of patients.